Rapid identification of Helicobacter pylori by capillary electrophoresis: an overview.

Helicobacter pylori can cause gastritis and peptic ulcers and is directly associated with the development of gastric cancer. There are many types of diagnostic methods used to identification H. pylori (invasive and non-invasive), but these methods usually require time-consuming and laborious procedures and therefore are not capable of fast diagnosis in cases of emergency. This contribution describes the new achievements, interdisciplinary significance and some future directions in the application of capillary electrophoresis for determination of H. pylori.

Preliminary study of volatile organic compounds from breath and stomach tissue by means of solid phase microextraction and gas chromatography-mass spectrometry.

The determination of volatile organic compounds (VOCs) in exhaled air and stomach tissue emission for the detection of cancer has been investigated. Solid phase microextraction (SPME) was used for sample preconcentration. The method presented in this paper showed satisfactory precision (RSD below 11%), linearity in the range of 2.8-136 ppb and limit of detection ranging from 0.6 to 2.1 ppb. The breath and emission from cancer tissue were collected from three patients with stomach cancer. Acetone, carbon disulfide, 2-propanol, ethyl alcohol and ethyl acetate were identified in breath and tissue samples. These compounds have been assumed as endogenous. Acetone ratio (AR) was calculated for carbon disulfide, 2-propanol and n-butane. The AR for carbon disulfide was found to be higher for normal tissue (20.64-44.95) than for emission from cancer tissue (2.01-18.20). A limitation of this study is that only a few clinical samples were investigated. These results should be evaluated as preliminary because of the small number of patients examined.

Multi-array antibody screening in detecting antibodies to mismatched HLA in patients awaiting a second transplant.

Effective identification of HLA specificities to which a prospective transplant recipient has antibodies depends on how effective the most sensitive assay is in detecting these antibodies. To ascertain the assay's efficacy, the results of antibody screening of patients on the waiting list for a second transplant were studied. A commercially available panel of fluoro-coded microbeads coated with multiple and single purified class I or II HLA antigens was used with flow cytometry to detect antibodies in human serum (LABScreen, One Lambda, Canoga Park, Calif, USA). A total of 112 HLA-A, B, and DR mismatches between donors and recipients were present among 34 patients. Antibodies to 56% of the mismatches were detected with 67% of the HLA-A, 38% of the HLA-B, and 63% of the HLA-DR mismatches detected, respectively. Thirty percent of the patients had antibodies to all of the mismatched HLA, 43% had antibodies to some, and 27% did not develop antibodies to any of the mismatched antigens. Among patients who developed antibodies to all of the mismatched HLA, 60% had had a transplant nephrectomy. Only 11% of patients who had no antibodies detected to mismatched HLA had had a transplant nephrectomy and 44% of them were still on immunosuppression. Using the Matchmaker program developed by Duquesnoy, the latter group of patients had a sufficient number of triplet mismatches that could have resulted in an antibody response. All of the undetected antibodies had been identified in other patients in this group. The assay used in this study to detect antibodies is considered the most sensitive one available. Nonetheless, antibodies to slightly less than half of the mismatched HLA antigens were not detected. It appears that the assay system is capable of detecting the antibodies, since in other patients with the same mismatched HLA, antibodies were detected. It is likely that the recipients could develop antibodies since there was a sufficient degree of disparity in the HLA of donors and recipients. Antibodies were more likely to be detected when there had been a transplant nephrectomy and the absence of immunosuppression. There was no way of knowing whether we were missing detecting antibodies or if they were not present. The results of this study have important implications with respect to utilizing "unacceptable antigens" in an allocation system for patients awaiting a second transplant.

Deterrents to R.T. continuing education.

Constant changes in medicine and technology make continuing education (CE) vitally important for radiologic technologists. Understanding what deters radiographers from participating in CE may help improve CE programs. This article reports on a survey of deterrents to CE participation among radiographers. Results revealed that cost was the leading deterrent, followed closely by work constraints. In addition, certificate-level radiographers found lack of quality to be a significantly higher deterrent than did radiographers with an associate degree.

Psychophysical evidence for losses in rod sensitivity in the aging visual system.

Rod sensitivity was measured with a criterion-free psychophysical method at 10 deg in the horizontal meridian of the nasal field of the left eye on 26 young (mean age, 24.1 yr) and 14 older (mean age 72.6 yr) observers in good ocular health. A 1 deg, 90 msec stimulus was delivered by means of a free-viewing optical system under computer control. Stimulus wavelengths were chosen to have either significant (406 nm) or minimal (560 nm) absorption by the older lens. After correction for senile miosis and lens density, 0.39 log unit higher thresholds for the older observers remained and are interpreted as being due to neural factors.

Ultraviolet laser-induced fluorescence of human stomach tissues: detection of cancer tissues by imaging techniques.

BACKGROUND AND OBJECTIVE: The background for this work was several literature reports on applications of the fluorescence methods to detection and localization of human cancers. The objective of our study has been to investigate if such an approach could be applied for the detection of gastric cancers. STUDY DESIGN/MATERIALS AND METHODS: Our study was designed in such a way that spectrally resolved images of laser-induced fluorescence of human gastric mucosa were collected and assessed from a point of view of elaborating an algorithm allowing for a differentiation between malignant and premalignant lesions and areas of normal mucosa. The method involved exciting the autofluorescence with ultraviolet light (325 nm, He-Cd laser). The images were recorded in vitro in six regions of a visible spectrum using a cooled CCD camera. The material for study was 21 resected specimens for which altogether 72 surface areas were examined. RESULTS: The main result is the observation that a difference of the fluorescence intensities measured at 440 nm and 395 nm, both normalized to intensity measured at 590 nm, differs significantly for the tissues of interest. CONCLUSION: Using that difference as a diagnostic parameter, it was possible to classify malignant tumor tissues with a sensitivity of 96% and a predictive value of 42%, whereas the same approach applied to abnormal but not tumor stomach tissues gave values of 80%, and 98%, respectively.

[Quality of life and long-term survival with intermittent self-ventilation in respiratory insufficiency caused by thoracic restrictive diseases]. / Lebensqualität und Langzeitüberleben unter intermittierender Selbstbeatmung bei Ateminsuffizienz infolge thorakal-restriktiver Erkrankungen.

BACKGROUND: Mortality and quality of life are to be assessed in patients with respiratory failure due to restrictive chest wall disease. Neither specific questionnaires, nor perspective studies are available. PATIENTS AND METHOD: In a retrospective analysis records of mortality and morbidity, physical and social activity, and duration of IPPV are reviewed. RESULTS: The group consists of 35 patients (mean age 56 +/- 12 years; 22 female, 13 male; 11 post tuberculosis, 24 kyphoskoliosis; IPPV duration 28.5 +/- 20.7 months). Five patients died, 3 of which during the first 4 months: In 3 death is related to respiratory symptoms, 1 is due to pulmonary embolism, 1 to disruption of aortic aneurysm. Hospitalisation is required by 12 patients in 20 instances with a mean duration of 14.2 days. Respiratory symptoms are the cause in 13 instances, special difficulties are met with occlusion of tracheostoma in 3 patients. Professional activity is performed by 14 of the 21 patients < 60 years old. Physical activity is severely reduced in 4 patients, while it is mildly to moderately compromised in 26. Seven of all patients need supplemental oxygen. CONCLUSION: In respiratory failure due to restrictive chest wall disease treatment with IPPV seems to improve long-term survival and to enhance quality of life.

Photophobia in patients with traumatic brain injury: Uses of light-filtering lenses to enhance contrast sensitivity and reading rate.

Patients who have sustained traumatic brain injury (TBI) often experience a new, intense and chronic photophobia. Photophobia, an intolerance to light, is an incompletely understood, subjective symptom, which has been divided into ocular and central types. Various commercial sources of light-filtering lenses have been developed, which have proven to be successful in diminishing visual symptoms expressed by patients who are photophobic. However, despite the many subjective reports of improved visual performance and comfort with use of these filters, there has been little documentation of actual enhanced visual sensitivity/efficiency. Letter contrast sensitivity (CS) and reading rate were measured in patients with TBI, who, despite good ocular health, experienced significant light intolerance. These patients exhibited up to two fold increases (0.3 log units) in binocular letter contrast sensitivity, as measured with the Pelli-Robson Letter CS Chart, in the presence of selected Corning Photochromic Filters (CPF), as compared to performance in the absence of CPF filters, or to that of similarly treated normal observers. These same patients demonstrated reading rates enhanced up to 39% above that measured in the presence of nearpoint optical correction alone. Reading performance of normal observers was unaffected by similar light filtration. These data provide objective evidence for improvement of visual function provided by light-filtering lenses in patients who become photophobic after TBI. Contrast sensitivity testing and assessment of reading rate add objective criteria for the clinical selection of light-filtering lenses in the treatment of TBI-induced photophobia.

[Diaphragmatic paralysis and respiratory insufficiency]. / Zwerchfellparese und respiratorische Insuffizienz.

BACKGROUND: Phrenic nerve palsy leads to disfunction of the main respiratory muscle. With bilateral palsy dyspnoea in the supine body position will typically occur. With one-sided lesion symptoms will only appear when a second pulmonary disease is present. PATIENTS: We refer of 6 patients with bilateral and 5 with unilateral diaphragmatic paresis. In 3 patients neuralgic shoulder-arm-amyotrophy was diagnosed, in further 4 there was suspicion of it. Amyotrophic lateral sclerosis developed in 2 after 4 respectively 8 months. In 1 case a cervical operation led to palsy, mediastinitis in 1 case. Lung function tests showed a restrictive pattern, especially in bilateral palsy. RESULTS: Vital capacity was reduced by almost 50% respectively 25% in the supine body position. Mouth occlusion pressure reduction was apparent. Near normal to marked hyperkapnia developed in bilateral paresis. In 5 cases non-invasive intermittent ventilation is instituted (2 volume controlled, 3 pressure supported). Two patients died (1 patient with amyotrophic lateral sclerosis after 13 months, 1 with malignant pleurisy after 4 months). Three patients continued non-invasive intermittent ventilation since 14 to 64 months.

[Intravascular ultrasound in preoperative diagnosis of central bronchial tumors--initial clinical experiences]. / Intravasale Sonographie zur präoperativen Diagnostik zentraler Bronchialtumoren--erste klinische Erfahrungen.

In the course of preoperative diagnosis, intravasal sonography for tumour imaging was conducted in three patients suffering from central bronchial carcinoma. The catheters of 6.0 or 4.8 French diameter were advanced in each case after pulmonary angiography via the left or right pulmonary artery up to the tumour area. Endosonographic tumour imaging was compared with the findings of the other preoperative diagnostic measures and in two cases with intraoperative and postoperative findings. The vascular walls of the central pulmonary arterial segments showed sonographically no typical three-layer structure. In all cases, however, tumour infiltration was showed up by disappearance of the vascular wall reflexes in the relevant pulmonary artery branches. Visualisation of the mediastinal pulmonary artery segments or of the main stem of the pulmonary artery is difficult with the wire-guided catheters used, since these cannot be stabilised in the centre of the vessel. Development of suitable catheters with low-frequency transducers and greater depth of penetration is imperative especially for the diagnostically important visualisation of the surrounding mediastinal structures.

[The echocardiographic demonstration of a right atrial thrombus and its embolization into the lung]. / Echokardiographischer Nachweis eines rechtsatrialen Thrombus und seiner Embolisation in die Lunge.

A 43-year-old man was hospitalized because of extensive bilateral pulmonary tuberculosis. After several weeks of tuberculostatic treatment--at first applied orally, then because of nausea and vomiting parenterally via a central venous catheter--he acutely developed nocturnal dyspnoea and symptoms of shock requiring artificial ventilation. Echocardiography demonstrated dilatation of the right ventricle and a large floating thrombus in the right atrium. During the examination complete displacement of the worm-like thrombus into the pulmonary artery was observed echocardiographically. Despite anticoagulation and immediate operation the patient died 2 days later of protracted shock. The thrombus was found to have been formed in the superior vena cava after placement of the central venous catheter.

[Evaluation of an anamnesis questionnaire for the diagnosis of sleep apnea in patients with chronic diseases of the respiratory organs]. / Validierung eines Anamnesebogens zur Diagnostik der Schlafapnoe bei Patienten mit chronischen Erkrankungen der Atmungsorgane.

In a Rehabilitation Clinic for Diseases of the Respiratory Organs we examined 497 male patients aged 45.9 +/- 11.1 years with a relative weight of 109 +/- 16.7% who were suffering from chronic diseases of the respiratory tract (66.2% chronic bronchitis, 33.8% asthma bronchiale, 49.6% obstruction of the respiratory tract). They were subjected to a detailed physical examination and were given an anamnestic questionnaire for the purpose of diagnosing sleep-related respiratory disturbances (Siegrist et al., 1987). In addition, whole body plethysmography was performed in all patients as well as a pulse-oximetric examination during night sleep. Using factor analysis, it was possible to extract 5 factors from the 23 items of the anamnesis questionnaire. With these 5 factors, 60.5% of the total variance could be explained. These factors describe: 1. Dyspnoea (35.3%); 2. Vigilance (8.5%); 3. Sleep disturbances (6.3%); 4. Headache (5.8%) and 5. Snoring (4.7%). Different factor patterns are seen for different groups of patients. In patients suspected of an obstructive sleep apnoea syndrome, however, it will always be necessary to perform further stage-wise diagnosis to safeguard the diagnosis.

Morphologic changes in human carcinoma cells (A-431) stimulated by epidermal growth factor: effect of cholesterol and low-density lipoproteins on the ruffling response.

Stimulation of A-431 carcinoma cells with epidermal growth factor (EGF) causes dramatic morphologic responses including ruffling, rounding, and bulk-phase pinocytosis. In attempts to explore the mechanisms responsible for changes in plasmalemma topography, we have investigated the effects of exogenous sterols thought to alter membrane fluidity. Light and scanning electron microscopy revealed a time- and concentration-dependent inhibition of ruffling (greater than 90%) by cholesterol. This effect could be duplicated by preincubation of the cells with comparable levels of low-density lipoproteins (LDL). EGF-stimulated bulk-phase endocytosis also is inhibited by treatment with cholesterol. No alteration of EGF binding, kinase stimulation, or internalization was detected in cells incubated in cholesterol-enriched medium (175 micrograms/ml in 0.5% ethanol), nor did cholesterol or LDL have any effect on EGF-stimulated rounding. Morphometry of electron micrographs from cholesterol-treated cells revealed a selective depletion of interdigitating lateral surface membrane that normally appears to be recruited to generate apical ruffles. Thus, the sterol inhibition of ruffling may be due to redistribution of plasmalemma rather than to changes in membrane viscosity. Together with previous observations, these data suggest that EGF-stimulated ruffling and bulk-phase pinocytosis are related phenomena, whereas EGF-stimulated cell rounding is an independent process.

[Effect of chronic inhaled pollutants (cigarette smoke) on trans-epithelial measured potential difference of nasal mucosa in the human]. / Einfluss chronischer Inhalationsnoxen (Zigarettenrauch) auf die transepithelial gemessene Potentialdifferenz der Nasenschleimhaut des Menschen.

The transepithelial potential difference of the mucosa of the nose is appreciably higher in non-smokers than in smokers with a moderate to heavy cigarette consumption. This reduced potential difference in response to chronic inhalation to noxae (cigarette smoke) is a marker for the change in the integrity of the mucosa of the nose, and may possibly be considered to be representative of the rest of the respiratory epithelium of the bronchial system.

[The significance of vasoactive intestinal polypeptide (VIP) in diagnosis of sleep apnea syndrome]. / Die Bedeutung des vasoaktiven intestinalen Polypeptids (VIP) in der Diagnostik des Schlafapnoe-Syndroms.

Vasoactive intestinal polypeptide (VIP) is a neurotransmitter of the non-adrenergic and non-cholinergic system (NANC). It has been detected in many organs, including the airways, central and peripheral nervous system, the blood, and CSF. As a result of neuronal overflow, vagal stimulation leads to an elevation of VIP levels in the plasma. VIP leads to the activation of adenyl-cyclase, and thus to elevated cAMP in cells bearing VIP receptors. In 25 patients (24 males, 1 female) with a mean age of 50.3 +/- 9.9 years, and a Broca Index of 134.5 +/- 27.0%, plasma VIP was measured in the morning under conditions of fasting with the aid of an RIA assay (Incstar). Eleven patients (mean age: 49.4 +/- 10.1 years, Broca: 130 +/- 27.0%) had fewer than 100 episodes of apnea during nocturnal sleep (apnea/hypoapnea index 4.4 +/- 4.8). At 6.3 +/- 1.6 pcmoll-1, plasma VIP was markedly lower than that measured in 14 patients (mean age: 51.0 +/- 10.0 years, Broca: 138 +/- 28%) with the sleep apnea syndrome (apnea/hypopnea index 58.5 +/- 24.7 (means = 11.0 +/- 3.0 pcmoll-1, p less than 0.001). A significant correlation was found between the apnea episode occurring every night, and the VIP values (r = 0.64; y = -133 + 40 x VIP) measured in the plasma. The VIP measured in the plasma would appear to be a highly sensitive and highly specific indicator of the appearance of episodes of apnea during nocturnal sleep.

[Study of the prevalence of sleep apnea syndrome in patients with chronic diseases of the respiratory organs using pulse oximetry and polysomnography]. / Untersuchungen zur Prävalenz des Schlafapnoe-Syndroms bei Patienten mit chronischen Erkrankungen der Atmungsorgane mittels Pulsoxymetrie und Polysomnographie.

In the literature, depending upon the group of subjects investigated and the diagnostic criteria applied, the prevalence of the sleep apnea syndrome (SAS) is reported to be between 1 and 10%. In the present study, 220 nonselected male patients (age range: 45.1 +/- 11.4 years, Brocca index 109.0 +/- 18.0%, 147 cases of chronic bronchitis, 65 of bronchial asthma, 8 with other diseases of the airways, 44.1% obstructive ventilation disturbances, 41.8% smokers) were investigated. As a screening method, nocturnal monitoring of oxygen saturation with the aid of a digital pulse oximeter (Draeger) was carried out. On average, 65.4 +/- 136.5 cases of desaturation to less than 90% SaO2/8 hours sleep were observed. In 48 patients with a Brocca index of more than 120%, desaturations at 156.1 +/- 244.5 were significantly more frequent than in 172 patients with a low relative weight (40.2 +/- 67.0, p less than 0.0001). Forty-eight patients (21.8%) revealed more than 80 episodes of SaO2 drops per night. Twenty-two patients were submitted to polysomnographic investigation. In 13 patients--6% of the overall group--who had more than 100 episodes of apnea/hypopnea (AHI 47.2 +/- 30.1), a sleep apnea syndrome was demonstrated.

[Personality markers in patients with sleep apnea syndrome]. / Persönlichkeitsmerkmale bei Personen mit Schlafapnoe-Syndrom.

In addition to the well-known medically oriented examination procedures and forms of treatment of sleep apnea, we are also interested in the psychological aspects of this pathological condition. Against the background of our experience of patients treated with nCPAP--here we have observed, among other things, an increase in general activity--we investigated the question as to whether typical personality traits are to be observed among persons suffering from sleep apnoea. As a psychodiagnostic procedure, the Freiburg personality inventory (FPI-R) was employed in the following persons: a) Persons with diagnosed sleep apnea, b) persons with unconfirmed suspected sleep apnea, c) persons with diagnosed chronic bronchitis. An initial consideration of the results reveals an unremarkable personality profile of the person with SAS who, however, in comparisons with other groups does reveal certain peculiarities. Although the results presented here do not permit any reliable specific psychodiagnostic statement to be made with the aid of the procedure employed, in several points they do provide clues as to features that should be subjected to a differential investigation.

Regulation of adrenergic stimulation of hepatic adenylate cyclase by divalent cations.

Liver plasma membrane adenylate cyclase was stimulated paradoxically by an alpha 2-adrenergic mechanism under conditions of low metal ion and low GTP concentrations. In untreated membranes, epinephrine stimulation was GTP-dependent and was mediated by beta-adrenergic receptors since it was completely blocked by propranolol, but unaffected by dihydroergocryptine. Pre-treatment of membranes to remove or reduce divalent cations and guanine nucleotides changed epinephrine stimulation to a form that was mediated by alpha 2-receptors since it was completely blocked by dihydroergocryptine, phenoxybenzamine and yohimbine, but not by propranolol or prazosin. The pre-treatment did not alter enzyme activation by isoproterenol or glucagon, alpha 2-Adrenergic stimulation of adenylate cyclase in depleted membranes required the presence in the assay of 1-2 mM Mg2+ and small amounts of exogenous GTP (less than or equal to 50 nM). Increasing the Mg2+ or GTP concentration in the assay produced a progressive reversal of epinephrine-stimulated activity from an alpha 2-adrenergic form to a predominantly beta-adrenergic form. Readdition of Ca2+ or Mg2+, but not Mn2+, into depleted membranes by incubation in the presence of metal reestablished the pattern of enzyme sensitivity to epinephrine to that seen with untreated membranes i.e., it changed from alpha 2- to beta-receptor mediation. Alterations in membrane and assay content of metal ions and GTP did not result in the activation of the enzyme by vasopressin or angiotensin II. These findings demonstrate the ability of Ca2+, Mg2+ and GTP to control the coupling of beta- and alpha 2-adrenergic receptors with liver adenylate cyclase. It is hypothesized that the cations act by regulating the interaction of the receptors with adrenergic agonists and/or the guanine nucleotide binding protein(s) which is postulated to be involved in control of the enzyme.